How a 4-Day Radiation Protocol After Surgery Reduces Keloid Recurrence

William Posten, MD, a dermatologist and Mohs surgeon at Advanced Dermasurgery Associates in Dallas, Texas, and the chief dermatologist of Sensus Healthcare, has practiced surgical dermatology for more than 22 years. In a recent Dermatology Times interview, he outlined the clinical rationale for radiation therapy after keloid surgery, its comparative efficacy, and the adherence requirements central to its success.

Outcomes and Recurrence Rates

Studies examining combined surgical excision and post-operative radiation therapy for keloids have shown a 90% success rate at the 5-year time point, Posten said.¹ He contrasted this sharply with conventional alternatives: intralesional corticosteroids carry a recurrence rate of approximately 90%, cryotherapy is comparable, and laser falls similarly short. The radiation protocol achieves its lower recurrence rate in large part by suppressing inflammation and fibroblast growth.

"This modality would have a recurrence rate of about 10%," Posten said. "I think a lot of that is due to the fact that the radiation does have a very suppressive effect on inflammation and fibroblast growth, which makes this really help with the adverse effects."

Adverse Effects in Context

Radiation carries known risks, but Posten noted these manifest very differently in keloid treatment versus skin cancer treatment. He regularly observes adverse effects when using radiation for skin cancers, but has not seen the same pattern in the keloid population. He acknowledged the risk exists, but characterized it as uncommon in this clinical context.

"We don't see that often when we treat keloids," Posten said. "I do see the risks and side effects with radiation when treating skin cancers, but have not seen that with keloids."

Patient Adherence and the 4-Day Protocol

Adherence is the most critical variable in this protocol, Posten emphasized. Surgery is performed on Monday, with radiation required on Tuesday, Wednesday, and Thursday—missing any session materially reduces the quoted success rate. He communicates this requirement explicitly during consultation so patients understand the commitment before proceeding.

"It is very critical to do the radiation immediately following the surgery," Posten said. "If you miss any of those days, that 90% cure rate or success rate we quote dramatically goes down."

Posten described the 90% figure as a substantial improvement over what was previously available for keloids, while noting the treatment is not 100% effective and recurrence, though uncommon, does occur.

Reference

1. Ogawa R, Tosa M, Dohi T, Akaishi S, Kuribayashi S. Surgical excision and postoperative radiotherapy for keloids. Scars Burn Heal. 2019;5:2059513119891113. doi:10.1177/2059513119891113